CY 2016 OPPS/ASC Proposed Rule: Ambulatory Surgical Center Quality Reporting Program Audio for this event is available via internet streaming. No telephone line is required. Computer speakers or headphones are necessary to listen to streaming audio. 1
Submitting Questions Type questions in the Chat with Presenter section, located in the bottomleft corner of your screen. 2
CY 2016 OPPS/ASC Proposed Rule: Ambulatory Surgical Center Quality Reporting (ASCQR) Program Anita Bhatia, PhD, MPH Centers for Medicare & Medicaid Services July 22, 2015
Learning Objectives At the conclusion of the program, attendees will be able to: Understand an overview of the ASCQR Program Identify where to find the Calendar Year (CY) 2016 OPPS/ASC proposed rule text and how to comment Understand proposed changes to the ASCQR Program Provide feedback on proposals, have concerns addressed, and ask questions 4
CY 2016 OPPS/ASC Proposed Rule Ambulatory Surgical Center Quality Reporting (ASCQR) Program Anita Bhatia, PhD, MPH Program Lead, ASCQR Program Centers for Medicare & Medicaid Services (CMS) 5
Proposed Rule CY 2016 Locating the Rule 6
ASCQR Program Rule History Rule Federal Register (FR) Reference Program Highlights CY 2015 OPPS/ASC 80 FR 39340 2 measures under consideration CY 2015 OPPS/ASC 79 FR 41044 1 new claims-based measure CY 2014 OPPS/ASC 78 FR 75122 3 web-based measures CY 2013 OPPS/ASC 77 FR 68492 No additional measures FY 2013 IPPS/LTCH PPS 77 FR 53637 Finalized requirements CY 2012 OPPS/ASC 79 FR 74492 Finalized 8 measures CY 2011 OPPS/ASC 75 FR 72109 Discussed, not implemented CY 2010 OPPS/ASC 74 FR 60656 Discussed, not implemented CY 2009 OPPS/ASC 73 FR 68780 Discussed, not implemented 7
Navigating the Federal Register (1 of 6) 8
Navigating the Federal Register (2 of 6) 9
Navigating the Federal Register (3 of 6) 10
Navigating the Federal Register (4 of 6) 11
Navigating the Federal Register (5 of 6) 12
Navigating the Federal Register (6 of 6) 13
Proposed Rule CY 2016 Measures Under Consideration 14
Measures Under Consideration Normothermia Outcome Unplanned Anterior Vitrectomy 15
Normothermia Outcome This measure assesses the percentage of patients having surgical procedures under general or neuraxial anesthesia of 60 minutes or more in duration who are normothermic within 15 minutes of arrival in the postanesthesia care unit. Impairment of thermoregulatory control due to anesthesia may result in perioperative hypothermia. Perioperative hypothermia is associated with numerous adverse outcomes, including cardiac complications, surgical site infections, impaired coagulation, and colligation of drug effects. 16
Normothermia Outcome When intraoperative normothermia is maintained, patients experience fewer adverse outcomes and their overall costs are lower. Addresses a significant area of medical care provided by ASCs and the Measures Application Partnership (MAP)- identified priority measure gap of anesthesia-related complications. Specifications for this measure for the ASC setting can be found at http://ascquality.org/documents/asc_qc_implementatio nguide_3.0_january_2015.pdf. 17
Unplanned Anterior Vitrectomy This measure assesses the percentage of cataract surgery patients who have an unplanned anterior vitrectomy (removal of the vitreous present in the anterior chamber of the eye). An unplanned anterior vitrectomy is performed when vitreous inadvertently prolapses into the anterior segment of the eye during cataract surgery. Although unplanned anterior rates are relatively low, this procedure complication may result in poor visual outcome, retinal detachment, and other complications. 18
Unplanned Anterior Vitrectomy Addresses a significant area of medical care provided by ASCs (cataract surgery) and the MAPidentified priority measure gap of procedure complications for the ASCQR Program. Specifications for this measure for the ASC setting can be found at: http://ascquality.org/documents/asc_qc_implemen tationguide_3.0_january_2015.pdf. 19
Measures Under Consideration Both measures have received conditional support from the MAP, pending the completion of reliability testing and National Quality Forum (NQF) endorsement. CMS invites public comment on the possible inclusion of these measures in the ASCQR Program measure set in the future. A summary of the MAP recommendations can be found at this website: http://www.qualityforum.org/setting_priorities/partnership/ measure_applications_partnership.aspx. 20
Proposed Rule CY 2016 Existing Policies and Proposed Changes 21
Public Reporting of ASCQR Program Data: Previously Finalized Previously, CMS finalized a policy to display the data at the CMS Certification Number (CCN) level in the CY 2012 OPPS/ASC final rule with comment period (76 FR 74514 through FR 74515). Generally, ASCs report quality measure data to CMS using their National Provider Identifier (NPI), which is their billing identifier on the CMS-1500 form as non-institutional billers. Additionally, payment determinations also are made by NPI. Because an ASC CCN can have multiple NPIs, publication of data by CCN can aggregate data for multiple facilities, thereby reducing identification of the individual facility. 22
Public Reporting of ASCQR Program Data: Update CMS proposed display of data according to NPI when data are submitted based on NPI to allow for identification of individual facility information, beginning with public reporting that occurs after January 1, 2016. This change will allow the public to distinguish between facilities, and will also help ASCs to better understand their performance on measures collected under the ASCQR Program. CMS invites public comment on our proposal to display data by NPI if the data are submitted by NPI and to display data by CCN if the data are submitted by CCN, and to codify this policy and our existing policies. 23
Administrative Requirements: Previously Finalized A Security Administrator is required to submit quality data to the QualityNet website via a web-based tool at www.qualitynet.org. For successful reporting, 50 percent of claims meeting measure specifications must contain appropriate Quality Data Codes (QDCs). Established a minimum case volume of 240 Medicare claims (primary and secondary) per year. Six web-based measures are reported via web-based tools: QualityNet and NHSN. No proposed changes to any of these policies. CMS proposes to codify these existing requirements. 24
Administrative Requirements: Previously Finalized Once an ASC submits any quality measure data on a Medicare claim, it would be considered as participating. An ASC that is participating and wishes to withdraw from the ASCQR Program must fill out an online withdrawal form available at www.qualitynet.org. An ASC that withdraws will incur a 2 percent reduction in its annual payment update and any subsequent year the ASC is not participating. Any and all quality measure data submitted could be made publicly available for the ASCs participating in the program. 25
Data Submission: Previously Finalized In the CY 2014 OPPS/ASC final rule with comment period, the data collection period for quality measures for which data are submitted via an online data submission tool as services furnished during the calendar year is two years prior to the finalized payment determination year. Previously finalized data would be submitted during the time period of January 1 to August 15 in the year prior to the affected payment determination year (78 FR 75137 through 75139). National Health Safety Network (NHSN) Influenza Vaccination Coverage among Healthcare Personnel data collection for CY 2016 payment is October 1, 2014 through March 31, 2015, with a submission deadline of May 15 of the year when the influenza season ends. 26
Data Submission: Update CMS is proposing to implement a May 15 deadline for all data submitted via a web-based tool in the ASCQR Program for the CY 2017 payment determination and subsequent years. This includes the following measures: ASC-6, ASC-7, ASC- 8, ASC-9, ASC-10, and ASC-11. CMS believes this deadline change will allow for earlier public reporting of measure data. This also will decrease the administrative burden for ASCs with multiple tracking submission deadlines. 27
Indian Health Services (IHS): Previously Finalized IHS facilities have been considered to be ASCs for purposes of the ASCQR Program due to their payment under the ASC payment system. IHS hospital outpatient departments are able to bill Medicare for ASC services and be paid based on the ASC Rates for Services under the ASC payment system. 28
IHS: Update CMS is now proposing that these facilities not be considered ASCs for the purposes of the ASCQR Program, beginning with the CY 2017 payment determination. To bill for ASC services, these IHS hospital outpatient departments must meet the conditions of participation for hospitals defined in 42 CFR, Part 482, and are not certified as separate ASC entities. CMS is proposing that these facilities not be considered ASCs for purposes of the ASCQR Program, beginning with the CY 2017 payment determination. There is also a proposal to codify this at the proposed new 42 CFR 416.305(d). 29
Extraordinary Circumstances: Previously Finalized Extraordinary Circumstances Extension or Exemptions No changes are being proposed to these requirements; however, there is a proposal to codify these existing procedures at the proposed new 42 CFR 416.310(e). 30
Reconsideration Process: Previously Finalized Reconsideration process details are available at www.qualitynet.org. Under the current reconsideration process, facilities are required to submit reconsideration requests by March 17 of the affected payment determination year (79 FR 53643). In some payment years, March 17 may fall outside of the business week. There is no appeal of any final ASCQR Program payment determination. 31
Reconsideration Process: Update CMS is proposing that, beginning with the CY 2017 payment determination, ASCs must submit a reconsideration request to CMS no later than the first business day on or after March 17 of the affected payment year. This is determined using the date the request was mailed or submitted to CMS. 32
Proposed Rule CY 2016 Commenting 33
Submitting Comments Comments must be received no later than 5 p.m. EST on August 31, 2015 if delivered by regular mail, express or overnight mail, or by hand or courier. Comments submitted electronically via regulations.gov will be accepted until 11:59 p.m. EST. CMS encourages submission of electronic comments to www.regulations.gov. Responses to comments will be in the final rule, to be issued in November 2015. 34
Submitting Comments 1. Enter CMS in the [Search for] box. 2. Select the [Search] button. 2 1 35
Submitting Comments 3. Filter: Comment Period = Open; Document Type = Proposed Rule 4. Scroll: Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; etc. 5. Select the [Comment Now] button. 4 3 5 36
Comment on Proposed Rule: Step 1 The system will guide you through a three-step comment process. Step 1. Enter your comment and contact information. a. Required fields have (Required) next to the field name. b. Comments can be up to 5,000 characters. a. b. 37
Comment on Proposed Rule: Step 1 (cont.) c. d. e. f. c. You can upload a file if you wish. d. Enter your contact information. e. If submitting a comment on behalf of a third party, enter the organization s name. f. When finished entering your comment and contact information, select the [Continue] button. 38
Comment on Proposed Rule: Step 2 Step 2. Your Preview: Shows how your comment* and information** will appear on regulations.gov. *Your Comment, files you uploaded, Country, and State or Province will appear on Regulations.gov. **Your Name, ZIP/Postal Code, and Organization Name will not appear on Regulations.gov. a. Select the [Edit] button to edit your comment and contact information. b. When finished previewing, check the box to acknowledge that you have read and understand the provisions of commenting. c. If all information is correct, select the [Submit Comment] button. b. c. a. 39
Comment on Proposed Rule: Step 3 Step 3. Your Receipt: Your comment is assigned a tracking number. Take a screenshot of this page or save your tracking number. You can use your tracking number to find out the status of your comment. xxx-yyyy-1234 40
Questions? 41
Proposed Rule CY 2016 Continuing Education Credit Process 42
Continuing Education Approval This program has been approved for 1.0 continuing education (CE) unit given by CE Provider #50-747 for the following professional organizations: Florida Board of Nursing Florida Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling Florida Board of Nursing Home Administrators Florida Council of Dietetics Florida Board of Pharmacy Professionals licensed in other states will receive a Certificate of Completion to submit to their licensing boards. 43
CE Credit Process Complete the ReadyTalk survey you will receive by email within the next 48 hours or the one that will pop up after the webinar. The survey will ask you to log in or register in order to access your personal account in the Learning Management Center. A one-time registration process is required. 44
CE Credit Process: Survey 45
CE Credit Process 46
CE Credit Process: New User 47
CE Credit Process: Existing User 48
Thank You for Participating! Please contact the ASCQR Support Contractor if you have any questions: Submit questions online through the QualityNet Question & Answer Tool at www.qualitynet.org Or Call the ASCQR Support Contractor at 866.800.8756. This material was prepared by the Outpatient Quality Reporting Outreach and Education Support Contractor under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). FL-OQR/ASC-Ch8-07152015-01 49